Alberta’s provincial government has introduced a bill that would allow surgeons to engage in private billing for surgical services, potentially reshaping the healthcare landscape in the province. The proposal, released in late November, would be economically beneficial to most providers. Doctors who have made the province’s healthcare workforce their battle cry are raising eyebrows. They question whether it can lead to meaningful improvement in capacity across the broader public healthcare system.
Dr. Braden Manns, a health policy expert, noted that while the new model may create financial incentives for some surgeons, it is unlikely to result in significant growth in the overall capacity of the healthcare system. So he raised his fears that resources would inevitably pivot away from judicial oversight. If the funding gets transferred from publicly funded care to out-of-pocket procedures, wait times for patients who depend on public services might get increased.
“The people that are forced to stay in the public system, those people who need the supports of a hospital, those people who can’t afford to pay that – they’re going to wait longer.” – Braden Manns
The provincial government believes that allowing surgeons to bill both public insurance plans and patients directly will encourage them to perform more surgeries. Maddison McKee, a government spokesperson, said this dual practice model represented exciting possibilities. It may prevent Alberta-registered physicians from working elsewhere providing private surgeries.
“Some Alberta-registered physicians, particularly orthopedic surgeons, currently leave the public system to perform private surgeries in other provinces; allowing dual practice here encourages them to stay, contributing to the public system while also providing private care at home.” – Maddison McKee
Right now, there are no limits on private surgery fees. This immunity from oversight allows their potential costs to soar into the thousands – even tens of thousands – of dollars per patient. This unregulated landscape raises deep equity issues regarding access to care. Worse still, it hits hardest on the people who can least afford excessive costs.
Dr. Stephen Kwan, president of the Alberta Orthopaedic Society and an orthopedic surgeon based in Lethbridge, highlighted additional challenges within the healthcare system. He ascribed the health risk to the lack of availability of Alberta surgeons due to onerous on-call shifts. He worried about the risks of scaring away new surgeons who wouldn’t be in it for the long haul.
“The problem with itinerant surgeons is that they come, they operate, they leave.” – Stephen Kwan
Dr. Kwan further observed that Alberta’s offer has only a small appeal to physicians. He proposed that only a limited number of specialists would be attracted to the concept of dual practice. He warned us not to expect a flood of new talent into the province.
Compare that to this year, when Alberta saw an influx of 643 new registered physicians. By September 30, 12,769 was the final count of physicians. As Dr. Kwan elaborated, supply is still very much tight in certain specialties. This includes profitable orthopedic and cataract surgeries, where the private opportunities have historically flourished.
“It’s exceedingly attractive if you get operating time in both the public as well as private systems.” – Stephen Kwan
Even with these challenges, McKee was pleased to report that the health workforce is still consistently growing. Throughout the panel she kept hope alive, expressing her belief that this new model would lead to better surgical outcomes.
“Of course, supply is tight, but the health workforce and the overall health system constantly expands.” – Maddison McKee
Additionally, Dr. Kwan spotlighted the cutthroat nature of surgical specialties within Alberta. While every market can create money-making silos, luring a consistent flow of talented surgeons is still a challenge, he said.
“It’s really like niche areas of practice where there are these markets that have developed, where you can develop profitable opportunities to provide those select services.” – Stephen Kwan
